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Functional Muscle Groups > Upper extremity > Flashcards

Upper extremity Flashcards

1
Q

Elbow Flexors (5)

A 
Biceps brachii
Brachialis (lateral side of biceps)
Brachioradialis
Pronator teres
Extensor carpi radialis longus

“3 Boys in PE”

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2
Q

Supination of Forearm (4)

A

Supinator
Extensor carpi radialis longus
Biceps brachii
Brachioradialis

“SEBB”

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3
Q

Wrist extensors (7)

A 
Extensor carpi ulnaris
Extensor carpi radialis longus
Extensor carpi radialis brevis
Extensor digitorum
Extensor digiti minimi
Extensor indicis
Extensor pollicis longus
  • All dorsal forearm muscles, 7E’s
  • Note: the top 3 can be gone and you still preserve wrist extension
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4
Q

Wrist flexors (7)

A 
Flexor carpi radialis
Flexor carpi ulnaris
Flexor digitorum superficialis
Flexor digitorum profundus
Flexor pollicis longus
Abductor pollicis longus
Palmer's longus

“5 F’s And Palm”

  • All median nerve innervated except for…
  • FCU and the ulnar half of FDP (ulnar n.)
  • Abductor pollicis longus (radial n.)
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5
Q

Elbow Extensors

A

Triceps

Anconeus

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6
Q

Elbow Pronators

A 
Pronator teres
Pronator quadratus
Palmaris longus
Bradioradialis
Flexor carpis radialis
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7
Q

APB (intrinsic thumb muscle) vs APL (extrinsic thumb muscle)

A

APB- ABduction from the palm (all the AFO muscles are median nerve innervated

APL- ABduction from the midline (“all peanut lovers”); affected in de quervain’s tendonitis)

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8
Q

Intrinsic muscles of the hand in their relative palmar anatomical position from lateral to medial

A 
All For One And One For All:
A: abductor pollicis brevis (APB)
F: flexor pollicis brevis (FPB)
O: opponent pollicis (under APB and FPB)
A: adductor pollicis
O: opponens digiti minimi
F: flexor digiti minimi
A: abductor digiti minimi

*Note: FPB may have ulnar and/or median innervation

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9
Q

Brachial plexus injury after median sternotomy

A

The medial cord is most vulnerable!

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10
Q

How to distinguish medial cord injury vs. ulnar neuropathy

A

Check the medial cutaneous nerve which comes off of the ulnar nerve–>
If the problem is medial cord, the medial cutaneous will be affected.
If the problem is the ulnar nerve, the medial cutaneous will be spared.
*Confirm this!

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11
Q

What nerve is vulnerable during axillary node dissection?

A

ICBN- intercostal brachial nerve

Clinically will have decreased sensation on the medial part of the upper arm

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12
Q

Thoracic outlet syndromes

A
  1. Interscalene
  2. Costoclavicular
  3. Pectoralis minor (coracoid process)
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13
Q

Axillary Nerve

A

Anterior division:

  • anterior deltoid
  • middle deltoid

Posterior Branch:

  • teres minor
  • posterior deltoid
  • sensory lateral shoulder

*Need to always examine: all 3 heads of the deltoid, teres major, and teres minor

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14
Q

Anterior interosseous branch of the median nerve supplies…

A

Flexor pollicis longus and pronator

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15
Q

Arcade of Struthers can be a site of entrapment of what nerve?

A

Ulnar nerve

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16
Q

What muscles are related to the Froment’s sign?

A

FPL and adductor pollicis

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17
Q

Froment’s sign is positive in which palsy?

A

Ulnar nerve palsy

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18
Q

Which muscle is not affected in PIN syndrome?

A

Extensor carpi radialis longus (ECRL)

*Radial nerve innervated before the radial nerve travels through the supinator to become the PIN)

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19
Q

Long head of the biceps

A

Insertion: on the glenoid

*intracapsular but extrasynovial–> therefore, not effected by diseases that affect synovial fluid

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20
Q

Triceps

A 
Lateral head (more c7?)
Long head (more c8?)
Medial head (more c8?)
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21
Q

Contraction of the triceps muscle can result in a mononeuropathy of what nerve?

A

Radial nerve– courses through the triceps in close proximity to the medial and lateral heads.

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22
Q

Common sites of Radial Nerve Compression Neuropathies

A

Axilla- crutch palsy
Arm- spiral groove (saturday night palsy), walker palsy (triceps)
Forearm- posterior interosseous syndrome, extrinsic compression (tumors, vascular lesions, etc.)
Wrist- superficial radial sensory branch (“cheiralgia paresthestica”), handcuff/wrist watch palsy

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23
Q

Arcade of Frohse

A

Where the radial nerve passes through the supinator muscle and becomes the PIN.

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24
Q

Anconeus

A

It’s innervation comes off the radial nerve before the spiral groove.
C8 muscle

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25
Q

Radial Nerve Muscular Branches

A 
Triceps brachii (3 heads)
Ancones
-------------------spiral groove
Brachioradialis
ECRL (directly next to brachioradialis)
Supinator
-------------------thru supinator (Arcade of Frohse)
so now PIN
ECRB?
EDC
EDM
ECU
APL
EPB
EPL
EIP
26
Q

4 anatomical areas for problems with the median nerve in so called “pronator syndrome”

A
  1. Ligament of Struthers (present in <1% of ppl)
  2. Lacertus fibrosis (fascial band off the biceps)
  3. Pronator teres
  4. Sublimes arch
27
Q

AIN

A
  • Largest motor branch of the median nerve
  • Runs on the anterior side of the forearm
  • Innervates 3 muscles: FPL, FDP (1/2), and PQ
  • pure motor nerve: contains no cutaneous fibers, but still carries pain fibers

*Always think of neuralgic amyotrophy–> AIN + serratus anterior–> self-limited

28
Q

AIN Syndrome

A
  • Acute onset of weakness of the thumb and index finger
  • Usually no sensory complaints
  • Clinical test: can’t make a circle with the thumb and index finger due to hyperextension of the PIP of the thumb
29
Q

4 sites of ulnar nerve entrapment

A

Arcade of Struthers (70% of ppl have this)
Retrocondylar groove/medial epicondylar groove
Cubital tunnel (as it passes through the two heads of the FCU)
Guyon Canal

30
Q

Flexor carpi ulnaris

A
  • Innervated by the ulnar nerve

- Makes up the floor of the cubital tunnel

31
Q

Flexor digitorum profundus

A

-ulnar part is innervated by a branch of the ulnar nerve that branches off after going through the cubital tunnel

32
Q

Medial collateral ligament of the elbow

A

-Same as ulnar collateral ligament

3 Components:

  • anterior oblique
  • posterior oblique ligament (forms the floor of the cubital tunnel)
  • small transverse ligament

*Note UCL reconstruction= Tommy John Surgery

33
Q

What forms the Guyon canal?

A

Medial: pisiform
Lateral: hook of the hamate
Floor: proximally traverse carpal ligament, distally pisohamate ligament

*Site for Ulnar nerve entrapment

34
Q

Froment’s sign= ulnar neuropathy

A 
Weak adductor polices (ulnar)
strong FPL (median)

To perform the test, a patient is asked to hold an object, usually a piece of paper, between their thumb and index finger.

35
Q

Coronoid process of ulna

A

Insertion of the brachialis muscle

Origin of the:

  • FDS
  • FDP
  • Pronator teres
  • +/- FPL
36
Q

Coracoid process of the scapular

A

Coracobrachialis
Pec Minor
Short head of the biceps brachii

37
Q

Chief function of the lumbricals

A

extension of the IP joints; secondary function is flexion of the MCP

38
Q

True claw-hand deformity is caused by injury to what nerves?

A

Median and ulnar nerves

39
Q

Stretching the intrinsic muscles of the fingers is best accomplished by…

A

hyperextending the MP joints and flexing the IP joints

40
Q

What are the functions of the flexor digitorum superficialis?

A
  • flexion at the PIP
  • flexion at the MCP
  • adduction of the digits (don’t forget!!!)
41
Q

What carpal bone in the proximal row receives muscular attachment?

A

pisiform

42
Q

DeQuervain’s is tenosynovitis of what muscles?

A
  • APL

- EPB

43
Q

“Extensor hood” is an extension of what tendon?

A

extensor digitorum longus tendon

44
Q

Spontaneous rupture of what tendon can be seen in RA?

A

extensor pollicis longus

45
Q

Complete lesions of both the median and ulnar nerves at the elbow will not abolish wrist flexion since this movement can still be performed by…?

A

Abductor pollicis longus (radial innervation)

46
Q

The flexors of the wrist joint are innervated by…?

A

Ulnar, median, and radial nerves

47
Q

Aberrant lumbricals can be a cause of…?

A

Carpal tunnel syndrome

48
Q

What lies deep to the flexor retinaculum (transverse carpal ligament)?

A

Median nerve

*Note: no arteries in the carpal tunnel

49
Q

What then does not go through the carpal tunnel?

A

FCR

50
Q

Weakness of the interosseous muscles?

A

Both sets (dorsal and palmar) are innervated by the deep branch of the ulnar nerve.

51
Q

AFO of the thenar and hypothenar

A
  • APB: important for pulp to pulp prehension
  • FPB: deep (ulnar n.) vs. superficial head (median n.)
  • Opponens
52
Q

Adductor pollicis

A
  • If weak, will see FPL substitute in Froment’s sign
  • Note that there is both a transverse and oblique head
  • In testing, make sure the thumb is not flexed
53
Q

Riche-Canniez Anastomosis

A
  • anomalous communication within the hand between motor branch of median nerve and deep branch of ulnar nerve
  • importance: abnormalities in first dorsal may reflect median nerve problem, not ulnar (32% have FPB entirely ulnar innervated, 33% have FPB entirely median innervated)
54
Q

Hand intrinsic muscles

A
  • thenar
  • hypothenar
  • adductor pollicis
  • dorsal interosseous

*Note: if you have an intrinsic minus hand, you don’t have nay of the above.

55
Q

Palmar interosseous

A
  • adduction of digits
  • assist MCP flex of index, ringer, and little finger
  • assist ext IP of index, ring, and little finger

*Note: the long finger has no palmer interosseous attached

56
Q

Dorsal interosseous

A
  • abduction of digits
  • assist MCP flexion
  • assist ext IP
57
Q

Lumbricals

A
  • originate from the tendons of the FDP
  • chief function is extension of the IP joints (reinforcing action of the EDC and interosseous)
  • secondary function can be MCP flexion if IPs extended

*Note: each lumbrical has same innervation as corresponding FDP (median and ulnar innervation); lumbricals really playing a coordinating role between flexor and extensor systems

58
Q

Finger extension

A
  • EDC goes to the fingers
  • Index and little finger both have an extra extensor
  • Middle and ring finger only have the EDC–> can’t extend the ring finger when the middle finger is flexed

*Note: to test the extensor indices proprius it is important to completely flex the MCP of long and ring fingers to eliminate action of EDC

59
Q

Adductor pollicis

A
  • If weak, will see FPL substitute in Froment’s sign (seen in ulnar nerve problems)
  • Careful when exploring the first dorsal interosseous to not go too deep otherwise you’ll be in the adductor policies
  • both a transverse and oblique head
  • in testing, be careful that the thumb is not flexed (to eliminate FPL action) and that the wrist is extended (to relax EPL).
60
Q

Compartments at the wrist

A
  1. APL, EPB
  2. ECRL, ECRB
    * lister’s tubercle
  3. EPL
  4. Ext digitorum and Ext indicis
  5. EDQ (ext. digiti minimi)
  6. ECU

Functional Muscle Groups (7 decks)

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